The present invention relates to an assessment technique, which is conveniently practiced on a computer. The computer is either a ‘stand alone’ or connected to a computer network, such as a local area network (LAN) or the world wide web, which is frequently and interchangeably referred to as the Internet. Other devices, including wireless enabled devices, may also be utilized in the assessment technique. The technique is particularly useful in the evaluation of the health of one or more persons.
In the United States alone, over 100 million people have chronic health conditions, accounting for an estimated $700 billion in annual medical costs. In an effort to control these medical costs, many healthcare providers have initiated outpatient or home healthcare programs for their patients. The potential benefits of these programs are particularly great for chronically ill patients who must treat their diseases on a daily basis. However, the success of these programs is dependent upon the ability of the healthcare providers to monitor their patients remotely in order to avert medical problems before they become complicated and costly.
Prior attempts to monitor patients remotely have also included the use of interactive telephone or video response systems. Such interactive systems are disclosed in U.S. Pat. No. 5,390,238; U.S. Pat. No. 5,434,611; as well as U.S. Pat. No. 5,441,047. These systems, however, have many shortcomings. One disadvantage of these systems is that they either require a patient to call in to a central facility to be monitored or require the central facility to call the patient according to a rigid monitoring schedule. Typically, if the patients are required to call the central facility, only the compliant patients will actually call regularly to be monitored, thereby undermining the purposes of monitoring the patients as a prophylactic measure. The non-compliant patients will wait until an emergency situation develops before contacting their healthcare provider, thus defeating the purpose of the monitoring system as a prophylactic measure. If the central facility calls each patient according to a monitoring schedule, it is intrusive to the patient's life. As a result, resistance to such monitoring will grow over time.
Improvements to monitoring systems have been proposed in the art. Examples of such systems include the following:
U.S. Pat. No. 5,997,476 describes a networked system for communicating information to an individual as well as remotely monitoring that individual. The system includes a server and a remote interface for entering in the server a set of queries to be answered by the individual. The server is a web server, and the remote interface is a personal computer or remote terminal connected to the server via the Internet. The system also includes a remotely programmable apparatus connected to the server via a communication network, preferably the Internet. The apparatus interacts with the individual in accordance with a script program received from the server, and the server includes a script generator for generating the script program from the set of queries entered through the remote interface. The script program is received and executed by the apparatus to communicate the queries to the individual, receive responses to the queries, and transmit the responses from the apparatus to the server.
U.S. Pat. No. 5,897,493 also describes a monitoring system that remotely queries an individual using a central computer system, a server, and a workstation networked to the server presenting a set of queries to be answered by the individual. Specific applications of the monitoring systems are, however, not discussed in detail.
Additionally, certain systems and techniques related to the evaluation of health, and more specifically health and/or behavioral indicia, are described in the following:
U.S. Pat. No. 5,882,203 describes a method for detecting depression and its severity. A series of statements formulated to detect the presence and severity of depression are presented to a subject in a multiple item visual analog format. The subject's answers are given a numerical value and the total score is then normatively ranked to determine the presence and severity of the depression. The method is optionally practiced with the use of a computer.
U.S. Pat. No. 5,967,789 describes a system to help a person stop or modify an adverse habitual health-related behavior, such as smoking, weight control, stress management, etc., by following a calculated regimen to commence on a day to be selected by the person. The system comprises a computer and a series of customized visually perceptible messages establishing a customized regimen to aid the person in stopping or modifying the adverse habitual health-related behavior. The computer receives personal information about the person, which is relevant to the behavior, and makes use of expertly designed system software to provide customized messages in response thereto. The customized messages are in the form of a daily sequence measured relative to a day selected by the person for the regimen to begin. Each of the messages is arranged to be read by the person in a specific sequence on a daily basis and includes respective numerical indicia representing the number of days from the selected day to the day of the message. The messages are provided to the person in various ways. For example, an electronic communication medium, such as the Internet, e-mail, facsimile, etc., delivers the messages to the person on a daily basis. Alternatively, the system can generate the cards or sheets in hard copy form and deliver them to the individual in a more traditional manner. The system may update and modify these messages based upon information provided by the person. Moreover, the system may provide the messages to a support person to aid the person wishing to change his/her health-related behavior.
U.S. Pat. No. 5,961,332 describes a method and an apparatus for processing data indicating an individual's psychological condition, psychological states, concomitant physiological states, and states of dysfunction along with principles, theories and research data to generate a diagnosis and a treatment plan for the individual. The apparatus also includes a remote user interactive means for providing remote access to and functionality of the apparatus.
U.S. Pat. No. 5,954,510 describes an interactive goal achievement system and method to assist persons in achieving and learning to achieve self-determined, measurable goals over time, while collecting data from a user on the user's progress toward achieving the goals. The system computes metrics from the data, gauges the user's progress towards achieving the goals, and provides the user with performance feedback. Further, the system collects additional information from the user regarding the user's estimate of the likelihood of achieving the stated goals, while also computing a separate objective estimate of the user's likelihood of achieving the goals. Preferably, a computer-based system implements the method, receiving and storing all of the collected information, computing the metrics, and generating the performance in the form of a progress report. Additionally, any suitable input device, such as a touch-tone telephone, for example, can be used to enter data into the computer system, while any suitable output device, such as a facsimile machine, can be used to provide the performance feedback to the user.
U.S. Pat. No. 5,940,801 describes a microprocessor-based diagnostic measurement apparatus and method for evaluating psychological conditions. The compact microprocessor-based unit produces a video display that prompts a patient or user to interactively operate one or more switches. The system records and analyzes information during an interactive diagnostic assessment procedure, which it then provides to a doctor or other health care professional. Such information can be used to determine whether clinical therapy and/or medication may be required. For example, the system utilizes a game-like video display to measure various neuropsychologic indicia of Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder.
U.S. Pat. No. 5,908,301 describes a method and device for modifying behavior. The device includes interactive pre-set and adjustable behavior modification tools, which are suitable for encouraging modification of various behaviors, such as reduced or increased food intake, tobacco use, and alcohol consumption. A user can select from a plurality of parameters to customize a program or accept the default program. The device monitors and, if selected by a user, adjusts any behavior sequence, including behavior actions and behavior intervals. If a user selects a preset program using the default parameters, then the device maintains no record of any behavior action or interval, and it selects, records, and adjusts all other programs automatically for the next behavior sequence. A display on the device shows the user the selected program and its operation. The device provides multiple output signals to alert a user when to begin the next behavior action; when the pre-determined number of behavior actions has been attained; when the pre-determined number of behavior actions is being exceeded; and a special alert signal. The device accepts and modifies, either automatically or manually, a user's intended goal and the rate at which the user desires to attain the goal. In relation to goal and rate, it accepts and modifies the user's physical condition at the start of each program, re-evaluating the progress and adjusting related programs accordingly.
U.S. Pat. No. 6,039,688 describes a therapeutic behavior modification program, compliance monitoring, and a feedback system. The system utilizes a computer to monitor a patient's behavior in achieving lifestyle changes necessary to maintain his or her health or recover from ailments or medical procedures. The system monitors the individual's compliance with the program by prompting the individual to enter health-related data, correlating the individual's entered data with the milestones in the behavior modification program, and generating compliance data indicative of the individual's progress toward achievement of the program milestones. The system's design revolves around a community of support, which includes a graphical electronic navigator, operable by the individual to control the microprocessor, for accessing different parts of the system.
U.S. Pat. No. 5,879,163 describes an on-line health education and feedback system using motivational driver profile coding and automated content fulfillment. An automated system and method provide customized health education to an individual at a remote terminal, which is directed to induce a modification in the individual's health-related behavior. The automated system includes a questionnaire generator for questioning the individual to determine his or her motivational drivers and comprehension capacity. A profile generator receives answers entered by the individual from the remote terminal and generates a motivational driver profile and a comprehension capacity profile of the individual. A translator receives clinical data relating to a current health condition of the individual and translates the clinical data, the motivational driver profile, and the comprehension capacity profile into a profile code. An educational fulfillment bank matches the profile code to matching educational materials and transfers the matched educational materials to the remote terminal. An evaluation program evaluates educational responses of the individual and provides profile updates for targeting subsequent educational materials to the individual based on the educational responses.
U.S. Pat. No. 4,627,818 describes a psycho-technological testing method and device. The method and device aid in determining the disposition, traits, and characteristics of human test subjects. The device formulates several sets of statements, each set being related to at least one trait. The device then divides the statements in each set into two groups that contain several pairs of complementary statements, each pair probing the same point from different perspectives. A test subject provides responses from a multiple choice menu. The device considers the responses on a group basis, and assigns a weight factor to each response. The device then uses templates, which contain assigned weighting factors for each response, to add up a score for each group of statements.
The prior art also includes certain systems and techniques for specialized evaluations relating to health care. Examples include the following systems:
U.S. Pat. No. 5,666,492 describes a computer based pharmaceutical care cognitive services management system and method. The system and method captures all of the value added by a pharmacist in a patient encounter by permitting multiple RARs (Reasons, Actions, Results) to be associated with a single SOAP (Subjective, Objective, Assessment, Plan). This system enables the pharmacist to financially recover for each analytical or counseling session and/or service provided to the user associated with a single transaction. The pharmaceutical care cognitive services management system and method also enables the efficient processing of interruptions to cognitive and counseling sessions. When a pharmacist receives an interruption in the nature of a patient telephone call, an in-person patient visit, or a call from a physician requesting a refill for a prescription, the pharmaceutical care cognitive services management system and method suspends the cognitive or counseling session for a first patient, processes the interrupt for the second patient, and upon completion of the processing of the interrupt for the second patient, resumes processing the cognitive or counseling session for the first patient.
U.S. Pat. No. 5,845,254 describes a method for objectively monitoring the performance of a group of health care providers. The method stores in-patient payment claim records, representative of in-patient health-care services performed for patients by the group health-care providers, and out-patient payment claim records, representative of out-patient health-care services performed for patients by the group health-care providers, in databases. The method then builds sickness episode data records from the in-patient payment claim records and the out-patient payment claim records. An objective severity adjustment analysis is then performed on the sickness episode data records to form severity-adjusted sickness episode data records. From the severity-adjusted sickness episode data records, a cost efficient performance level is determined for each individual health-care provider within the group and a qualitative performance level for the group as a whole.
The prior art also includes various surveys that are not necessarily practiced utilizing a computer or computer system.
SF-36 Health Survey—Manual & Interpretation Guide, written by John H. Ware, Jr., Ph.D. et al., and published by The Health Institute, New England Medical Center, Boston, Mass. (copyright, 1993) describes a protocol for an improved health assessment and evaluation technique. The guide includes a thirty-six question survey, which is useful in assessing general health variables. Many have cited the thirty-six question survey as providing excellent results notwithstanding its brevity as compared to other surveys.
“Dynamic Health Assessments: The Search for More Practical and More Precise Outcomes Measures” by John E. Ware, Jr., Jakob Bjorner and Mark Kosinski, published in the Quality of Life newsletter, No. 21 (January-April 1999) generally discusses a psychometric method for assessing indicia of ideal health status.
An article related to the SF-36 survey is “The MOS 36-Item Short Form Health Survey (SF-36)” by John H Ware Jr., PhD. and Cathy Donald Shelbourne, PhD, published in Medical Care, Vol. 30, No. 6, June 1992.
A further article related to certain computer testing algorithms is described at pages 103-135 of Computer Adaptive Testing—A Primer by Howard Wainer, et al. published by Lawrence Erlbaum Associates, Hillsdale, N.J. 1990.
While many of these systems, methods and surveys offer certain advantages, they are fraught with shortcomings, which curtail their utility as well as their popularity. One such shortcoming is the length of the tests or surveys. As is well known, a test or survey has to be statistically significant to be considered an accurate instrument in evaluating a patient or respondent. As is also well known in the art, a greater number of questions generally leads to more statistically significant results. However, while a long test or survey having a large number of questions may provide improved statistical accuracy, it also places greater burden on the patient or respondent. The patient/respondent becomes reluctant to participate in the survey, particularly when it is given at a periodic interval. This reluctance manifests itself in (i) the failure of the patient/respondent to take the survey at prescribed time interval; (ii) the failure of the patient/respondent to participate in the survey altogether; (iii) the omission by the patient/respondent of one or more questions, which, of course, detracts from the statistical accuracy of the test; and (iv) an overall inconsistency in the responses of the patient/respondent. For example, a subset of questions directed towards evaluating a very specific condition or area of interest, which are divided and scattered throughout the survey, might not receive consistent responses. This result is particularly true when a large number of questions separate the related questions. Again, inconsistent answers reduce the overall statistical accuracy of the survey, as well as its perceived validity.
A further shortcoming in these surveys is that they are often directed towards providing an objective evaluation of a patient and his/her health. This method of evaluation doesn't allow a patient to provide their own feedback as to their own perceived state of health, which can be a significant distinction. Although, the objective evaluation of the patient and his/her health provides the healthcare practitioner or healthcare provider with objective indicia as to the perceived state of the patient's health, it is not necessarily helpful in all instances to the patient in understanding his/her health status or progress during any particular time interval. That is, the objective survey results are not frequently presented in a meaningful fashion to the patient. Rather, many of these surveys are primarily directed to the healthcare provider or healthcare organization. A subjective survey is much more meaningful to the patient in understanding their own health status and progress over any time interval. Healthcare providers/healthcare organizations, however, rarely utilize such subjective surveys, and traditionally favor the objective types of surveys known to the art.
Another shortcoming relating to the systems, methods, and surveys, which are cited above, is the relevant inflexibility of the surveys, which are set out in a standardized form and need to be completed in total by the patient/respondent every time that the survey is taken. Thus, patient/respondent encounters the same burden every time that he or she responds to such survey.
Furthermore, the prior art tests and surveys are non-adaptive. Prior survey results of a patient/respondent, or a group of patients/respondents, do not affect the future surveys that they are given. As such, the later surveys do not provide for differentiation in the health status of a patient.
An additional problem in the prior art surveys is their inflexible modes of administration. The surveys generally consist of either the traditional paper-based type or a computer-based replica of the same. The traditional paper-based versions provide a series of questions on paper sheets or booklets for the patient/respondent. After the patient/respondent completes the survey, the administrators evaluate the responses. While cost effective, the format remains inflexible. In the case of the computer-based surveys, many of the prior art surveys are little more than computer-driven versions of the same paper-based surveys, which provide little or nothing in added flexibility.
A further shortcoming in many of the prior art surveys is that they are unsuited for self-administration by a patient/respondent. In the context of the objective surveys described above, the patient/respondent may be very capable of taking the survey and responding to the questions provided therein, but many of these surveys do not provide an immediate response that is readily understood by the patient/respondent by the conclusion of the survey. Thus, while the “objective” type survey may provide meaningful results to a medical practitioner or a health services organization, it is not particularly adapted as a self-monitoring instrument to a patient or respondent.
Accordingly, there is a real and continued need in the art for improved systems and methods for the monitoring and assessment of a patient's health.
There is also a need for improved health assessment and monitoring systems that provide more accuracy in assessing and/or monitoring a patient's health, and that can be flexibly administered to one or more subject respondents/patients.
Further, there is a need for such systems as aforesaid that are less burdensome to administer to a patient than prior art systems.
There is also a need for such systems as aforesaid that are less burdensome on patients in their effort to participate in such systems.
It is appreciated that these are but representative of certain needs in the art which various aspects of the present invention address and provide.